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- Title
Pedicled and free flaps for intrathoracic fistula management.
- Authors
Fricke, Alba; Bannasch, Holger; Klein, Henriette F.; Wiesemann, Sebastian; Samson-Himmelstjerna, Patrick; Passlick, Bernward; Beyersdorf, Friedhelm; Hoeppner, Jens; Penna, Vincenzo; Eisenhardt, Steffen U.; Stark, Björn G.; Koulaxouzidis, Georgios
- Abstract
OBJECTIVES: Intrathoracic fistulae are among the potential sequelae of radiation therapy, empyema and abscess clearance and surgical tumour resections. Interdisciplinary plastic-reconstructive flap surgery is a helpful tool for the successful treatment of intrathoracic fistulae. METHODS: From February 2006 to April 2016, 13 patients (3 females and 10 males) underwent flap surgery for bronchial (n = 5), tracheal (n = 2), oesophageal (n = 2), post-pneumonectomy bronchopleural fistula (n = 2), tracheo-oesophageal (n = 1), gastrobronchial (n = 1) and oesophagobronchial (n = 1) fistulae. Patient characteristics, identified pathogenic micro-organisms, treatment and decision criteria, longterm outcome and postoperative complications were evaluated by analysing patient charts and surgical reports. RESULTS: The mean age of the 13 patients who underwent reconstructive surgery was 55.5 years (range: 42-66 years). The median followup time was 31.4 months (range: 2-96 months). American Society of Anaesthesiologists classification was II for 1 patient, III for 8 patients and IV for 4 patients. In total, 18 flaps were performed (7 latissimus dorsi pedicled flaps, 7 pectoralis major pedicled flaps, 2 rectus abdominis myocutaneous flaps, 1 free temporo-parietal fascia flap and 1 intercostal muscle flap). A second flap was indicated in 5 cases (38.5%) due to fistula recurrence; of these, 1 patient developed a bronchial fistula after successful reconstruction of a gastrobronchial fistula. Eight of the 13 patients (61.5%) were evaluated postoperatively at regular intervals for at least 1 year and showed no signs of fistula recurrence. CONCLUSIONS: Our study showed that plastic-reconstructive flap surgery, although associated with significant morbidity and mortality, can be a life-saving tool for intrathoracic fistula reconstruction. Clinical Trial Registration: DRKS00010447.
- Subjects
BRONCHIAL fistula; ABSCESS treatment; ESOPHAGEAL fistula; EMPYEMA; POSTOPERATIVE care; DIAGNOSIS
- Publication
European Journal of Cardio-Thoracic Surgery, 2017, Vol 52, Issue 6, p1211
- ISSN
1010-7940
- Publication type
Article
- DOI
10.1093/ejcts/ezx216